THE ROLES AND RESPONSIBILITIES OF ROLE PLAYERS IN SCHOOL-BASED HIV AND AIDS PREVENTIONPROGRAMMES

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CHAPTER 4 DATA ANALYSIS AND INTERPRETATION

INTRODUCTION

This chapter presents the analysis, description and interpretation of the findings of the data collected from the study carried out to develop guidelines for local role players to implement the school-based HIV and AIDS prevention programme in Bushbuckridge, Mpumalanga. The frame of reference for the study was to explore the roles and challenges of local role players in the implementation of the school-based HIV and AIDS prevention programmes as required by the Integrated School Health Policy (ISHP). In addition, guidelines had to be developed to ensure the effective, efficient and relevant implementation of the school-based HIV and AIDS prevention programme.
The study was designed to collect data using focus group interviews (FGIs) and individual face to face interviews. The FGIs data was collected at two schools, school A with eight participants and school B with eleven participants. Participants in both schools consisted of senior members of the school personnel and Life Orientation educators and those who were part of the SGB and identified by the principal of each school. The semi-structured individual interviews were conducted with one of the senior members in the district health, five primary healthcare (PHC) nurses working in the community health centre (CHC), four professional nurses working in the clinic, and two NGO members as indicated in Chapter 3.
The documentation and analysis process aimed to present data in an enabling way to identify trends and relations in accordance with the research objectives. In turn, the identified roles and challenges in accordance with the research objectives would enable the researcher to develop guidelines for local role players to implement the school-based HIV and AIDS prevention programme in Bushbuckridge.

PHASE 1

This was the empirical phase and addressed the roles and challenges of local role players in the implementation of the school-based HIV and AIDS prevention programme. After briefly restating the data analysis process, the findings of the two methods of data collection are presented and discussed as a single unit of analysis (refer to Table 4.1).

Empirical data analysis and presentation of findings

In qualitative research data analysis is a process of examining and interpreting data to elicit meaning, gain understanding, and develop empirical knowledge (Corbin and Strauss (2008:47) cited by Grove, et al 2013:279). In this study, the researcher organised, gave structure, and elicited meaning from the data provided by the participants in accordance with the purpose of data analysis as described by Polit and Beck (2012:556). The researcher applied a constructivist philosophical perspective (often referred to as the naturalistic paradigm) in an attempt to understand, describe and interpret the roles and challenges experienced by the local role players to implement the school-based HIV and AIDS prevention programme in high school settings.
The recorded FGIs and semi-structured individual interviews were transcribed verbatim. The transcripts were coded using Tesch’s method of data analysis as described in Creswell (2009:192) (Refer to Chapter 3). Kreuger, Neuman, Robson (2011:408) view the analysis and interpretation of data as a process; the products of the analysis thereof provide the bases for interpretation and analysis. It is an important exercise to go through in a study. Robson (2011:468) states the central requirement in qualitative analysis is clear thinking on the part of the analyst. The current researcher was able to analyse statements, produce valid arguments as well as initiate logical discussions.The findings of the two methods of data collection were presented and discussed as a single unit of analysis. This was done to enrich the analysis and to avoid repetition.
Managing the mass of raw, transcribed data meant ordering it systematically and methodically into manageable chunks to attain themes, categories and subcategories (Polit and Beck 2012:557-60). A theme is described by Polit and Beck (2012:562) as “an abstract entity that brings meaning and identity” to how a situation or experience is at present and how it is manifested. Thus, the capturing of themes, categories and subcategories unifies the nature or basics of the situation or experience into a meaningful whole (Polit and Beck 2012:562). Field notes taken during the interviews in the current study augmented the interpretation of the meaning of participants’ words.
In this study the information obtained from the single unit data analysis was of sufficient quality to be turned into themes, categories and subcategories that pertained directly to roles of the local role players in the implementation of the school-based HIV and AIDS prevention programmes, the challenges they experienced and the guidelines needed to ensure the effective implementation of these programmes.

Theme 1: The roles of local role players in school-based HIV and AIDS prevention programme

HIV and AIDS health services are aimed at meeting the needs of all learners who are affected by knowing or staying with a person/s living with HIV and AIDS or learners who are living with HIV and AIDS themselves. The services offered by nurses, educators or NGOs are related to the promotion, prevention and initiation of treatment and appropriate follow-up. All participants in the study were asked about their current roles in the school-based HIV and AIDS prevention programme offered for learners. The enquiry centred on what the service exactly is, its content, the method or strategy used for HIV and AIDS education, skills needed as well as information sources.
Three (3) major themes were identified. Eleven (11) categories and 35 subcategories substantiated the three themes. The combined findings are presented first in a summarised table format in Table 4.1. The combined findings are reported, interpreted and rich descriptions of the themes, categories and subcategories are given. The verbatim quotes used to support the findings as interpreted by the researcher are written in italics. Operational introductions, clarities and/or definitions for each category are given.

Category 1: HIV and AIDS health services (nurses)

HIV and AIDS health services (nurses) emerged as the first main category of theme 1; the roles of local role players in school-based HIV and AIDS prevention programme. It was subdivided into three subcategories: youth-friendly clinic; clinic visits; and screening and health education (to learners and educators) as shown in Table 4.2.
The nurse participants in the study indicated that it was their responsibility to provide HIV and AIDS health services to the learners. The findings revealed health services were provided in the form of a youth-friendly clinic and clinic visits. Screening and health education formed part of the services and activities rendered by nurses in youth-friendly clinics and during clinic visits.

Youth-friendly clinic

The participants were professional nurses from the clinic and the community health centre. The clinic is close to the high school in Acornhoek and the community health centre (CHC) is near the high school in Thulamahashe. They all confirmed the services they provided were youth-friendly and that rendering sexual and reproductive health services (SRH) was part of the role they fulfilled in the implementation of the school-based HIV and AIDS prevention programme. The following quotes from the clinic nurses verify this finding:

• “We run a youth-friendly clinic in this clinic every day. In this clinic we only see the youth and most of them are from the nearby school.” (Clinic Participant no. 3)
• “We are having a youth-friendly clinic which is run especially during the weekends, so we teach the youth about STI, HIV, TB and family planning.”(Clinic Participant no.1)
• “We are having a youth-friendly clinic which is run especially during the weekends.” (Clinic Participant no. 2)

A youth-friendly clinic (YFC) is a clinic offering integrated healthcare for the youth ‒ meaning the approach to care in the clinic encompasses the following key components of what is regarded as youth-friendly clinical services: confidentiality, respectful treatment, integrated service, culturally appropriate care, free or low-cost services, and easy access (WHO 2012a:30). Making health services adolescent friendly: developing national quality standards for adolescent-friendly health services OR Adolescent friendly health services: an agenda for change. Sexual and reproductive health services (SRH) offered in a youth-friendly clinic consist of an education and counselling component, contraceptive services, STI/HIV testing and treatment, and attending to other health concerns linked with physical intimacy. These clinics actively promote parent/child communication regarding the latter’s sexuality. Providing a health service that is youth-friendly is a key strategy for improving young people’s health (Geary, Gomes-Olive, Kahn, Tollman and Norris 2014: I).
Participants from the CHC agreed that providing youth-friendly services is a pivotal role nurses fulfil in the implementation of the HIV and AIDS prevention programmes in local high schools. These participants expressed their roles as youth-friendly counsellors, advisors and educators in the following ways:
“Oh, we have a youth-friendly clinic every day in the CHC … there are guys here who are particularly dealing with the youth.” (CHC Participant no. 1)
“We do not have a formal programme but we do go for just lessons to teach, to give them health educations…sometimes in a while. But most of the time we do call, we have the children comes on weekends, Saturdays, for health education concerning prevention. And each and every time when each client comes to the clinic we counsel them on HIV and then we offer them HIV testing; which is a daily thing.” (CHC Participant no. 3)
“We screen them when they come to the youth-friendly clinic, but one thing for sure, we educate them.”(CHC Participant no.2)
Both the clinic and the CHC could be accessed by learners during the week or over a weekend ‒ although at the CHC only on a Saturday ‒ when screening, counselling and testing for HIV and AIDS and health education regarding STIs and family planning services were provided in an informal way. Casually educating high school learners in a setting they have easy access to by “guys here who are particularly dealing with the youth” links unmistakeably to the observation made by Geary, Gomes-Olive, Kahn, Tollman and Norris (2014:I) that sexual and reproductive health services (SRH) offered in a youth-friendly clinic consist of an education and counselling component, contraceptive services, STI/HIV testing and treatment, and attending to other health concerns linked with physical intimacy. The nurses in Bushbuckridge clearly endeavoured to do their utmost to accommodate the learners’ sexual health needs which included specifically health-related HIV and AIDS issues. Providing a health service that is youth-friendly is a key strategy for improving young people’s health (Geary, et al 2014: I).
From literature it seems as if confidentiality ‒ which linked to anonymity and privacy ‒ is a major issue among learners. Learners who feel confident and at ease with educators tend to open up when talking about sexual health and personal issues with adults or experienced professionals they feel they can trust. This is an important aspect of learners’ SRH and HIV and AIDS educational initiatives ‒ learners must trust educators; this may lead to increased awareness and knowledge about STIs and may serve to reduce high-risk behaviour (Bana, Bhat, Godlwana, Libazi, Maholwana, Marafungana, et al 2010:157).
Participants from the clinic informed that SRH services were readily available and accessible to the youth from the local high schools over weekends. They confirmed attendance by learners over weekends was fruitful since latter were more willing to visit the clinic over weekends for “personalised care” which they felt was more “confidential”. The chances of friends and family members recognising them which could lead to criticism or victimisation were minimal. Participants described learners who attended the clinic over weekends as follows:
“The students [learners]are happy and always willing to come on weekends to the clinic, because they know they will receive personalised care.”(Clinic Participant no. 4)
“You know what, on weekends, there are less people and chances that they [are] seen by others or relatives, who may go out and gossip about them, is very small. They are very free.”(CHC Participant no.1)
Although the findings indicated that the clinic as well as CHC nurses regarded the services they provided as youth-friendly Sexual Reproductive Health services, questions about the implementation of the Integrated School Health Policy (ISHP) by the relevant institutions and role players were met with ignorance in both the Acornhoek and the Thulamahashe high schools. Quotes from the nurses, educators and NGO members confirmed there was lack of knowledge concerning the guidelines for the school-based HIV and AIDS prevention programme as stipulated in the Integrated School Health Policy (ISHP):
“No we don’t know it [ISHP]….”(Participant no 2. FGI School A)
“I have never heard anything about such a policy.” (Participant no. 1 FGI School A)
“We don’t know of that. Or am I the only one who does not know this policy?”(Participant no. 3 FGI School B)
The above verbatim quotes from the focus group interviews (FGIs) conducted in the high schools signify a lack of knowledge among educators about the ISHP. Conversely, the findings from the interviews with the nurses working in the CHC and the clinic suggest that while they were aware of the Integrated School Health Policy, they had no accurate information about its content. Further responses from the nurse participants in this regard included:
“I am aware that there is that policy. Yes, I did go through it but I didn’t finish you know. I didn’t go through it, but the policy is there, I have seen it.”(CHC Participant no. 2)
“I didn’t get the time to go through it.” (Clinic Participant no. 4)
“I haven’t had time to go through it, you know … and the shortage of staff is killing us.”(CHC Participant no. 5)

DECLARATION 
ACKNOWLEDGEMENT 
DEDICATION 
ABSTRACT 
LIST OF ABBREVIATIONS AND ACRONYMS 
TABLE OF CONTENT
CHAPTER 1 BACKGROUND AND ORIENTATION OF THE STUDY
1.1 INTRODUCTION
1.2 PROBLEM STATEMENT
1.3 RATIONALE
1.4 THE AIM AND RESEARCH PURPOSE
1.5 RESEARCH OBJECTIVES
1.6 DELINEATION OF THE STUDY
1.7 DEFINITIONS OF KEY CONCEPTS
1.7.1 Local role players
1.7.2 Implementation
1.7.3 HIV and AIDS prevention
1.7.4 Programme
1.8 RESEARCH PARADIGM
1.8.1 Ontology
1.8.2 Epistemology
1.8.3 Methodology
1.9 THEORETICAL FRAMEWORK
1.9.1 The individual
1.9.2 Interpersonal
1.9.3 The organisational
1.9.4 Community
1.9.5 Public policy
1.10 RESEARCH DESIGN AND METHODOLOGY
1.10.1 Phase 1: Empirical phase
1.10.1.1 Qualitative design
1.10.1.2 Exploratory research
1.10.1.3 Descriptive research
1.10.1.4 Research context
1.10.1.5 Population
1.10.1.6 Sampling
1.10.1.7 Inclusion criteria
1.10.1.8 Data collection plan and implementation
1.10.1.9 Data analysis
1.10.1.10 Ethical considerations
1.10.2 Phase 2: Development and description of guidelines
1.10.2.1 Development of guidelines
1.10.2.2 Selection of experts
1.10.2.3 Data collection method
1.10.2.4 Data analysis
1.11 ORGANISATION OF THE STUDY
1.12 CONCLUSION
CHAPTER 2 THEORETICAL FRAMEWORK
2.1 INTRODUCTION
2.2 THE IMPORTANCE OF USING A THEORETICAL / CONCEPTUAL FRAMEWORK
2.2.1 Benefits of using theoretical frameworks
2.3 OVERVIEW OF THE SOCIAL ECOLOGICAL MODEL
2.3.1 The individual
2.3.2 Interpersonal
2.3.3 The organisational settings
2.3.4 Community
2.3.5 Public policy
2.4 ASSUMPTIONS AND CORE PRINCIPLES OF THE SOCIAL ECOLOGICAL MODEL (SEM)
2.4.1 Multiple factors influence behaviours
2.4.2 Environments are multidimensional and complex
2.4.3 Human-environment interactions can be described at varying levels of organisation
2.4.4 The interrelationships between people and their environments are dynamic
2.5 THE REASONS FOR USING THE SOCIAL ECOLOGICAL MODEL IN THIS STUDY
2.6 CONCLUSION
CHAPTER 3 RESEARCH METHODOLOGY
3.1 INTRODUCTION
3.2 RESEARCH PARADIGM
3.2.1 Paradigm
3.2.1.1 Constructivist naturalistic paradigm
3.2.2 Major assumptions of the constructivist naturalistic paradigm
3.2.2.1 Ontology
3.2.2.2 Epistemology
3.3 RESEARCH DESIGN, RATIONALE AND METHODS
3.3.1 Qualitative design
3.3.2 Exploratory research
3.3.3 Descriptive research
3.4 RESEARCH SETTINGS/ CONTEXT
3.5 POPULATION
3.5.1 Sampling
3.5.2 Inclusion criteria
3.6 DATA COLLECTING METHODS
3.6.1 Pilot study
3.6.2 Data collection strategies
3.6.2.1 Focus groups interviews
3.6.2.2 Semi-structured individual interviews
3.6.2.3 Field notes
3.7 DATA ANALYSIS METHODS
3.8 TRUSTWORTHINESS
3.9 CONCLUSION
CHAPTER 4 DATA ANALYSIS AND INTERPRETATION
4.1 INTRODUCTION
4.2 PHASE 1
4.3 FIELD NOTES
4.4 CONCLUSION
CHAPTER 5 DISCUSSION OF FINDINGS AND LITERATURE CONTROL
5.1 INTRODUCTION
5.2 DISCUSSION OF THE FINDINGS WITH LITERATURE CONTROL
5.2.1 THE ROLES AND RESPONSIBILITIES OF ROLE PLAYERS IN SCHOOL-BASED HIV AND AIDS PREVENTIONPROGRAMMES
5.2.2 THEME 2: CHALLENGES WITH SCHOOL-BASED HIV AND AIDS PREVENTION PROGRAMMES
5.2.3 THEME 3: SUGGESTIONS/ NEEDS FOR HIV AND AIDS PREVENTION PROGRAMME
5.3 CONCLUSION
CHAPTER 6 INTERPRETATION OF THE FINDINGS IN RELATION TO THE SOCIAL ECOLOGICAL MODEL
6.1 INTRODUCTION
6.2 OVERVIEW OF THE SOCIAL ECOLOGICAL MODEL
6.3 ASSUMPTIONS AND CORE PRINCIPLES OF THE SOCIAL ECOLOGICAL MODEL (SEM)
6.4 REASONS FOR CHOOSING THE SOCIAL ECOLOGICAL MODEL IN THIS STUDY
6.5 CRITIQUE OF THE MODEL
6.6 ALIGNMENT OF THE FINDINGS TO THE MODEL
6.7 THE SYNTHESIS AND CONCLUSION OF THE FINDINGS WITH REFERENCE TO SEM
6.8 PRELIMINARY GUIDELINES
6.9 CONCLUSION
CHAPTER 7 DEVELOPMENT AND REFINEMENT OF GUIDELINES FOR LOCAL ROLE PLAYERS TO IMPLEMENT THE SCHOOL-BASED HIV AND AIDS PREVENTION PROGRAMME
7.1 INTRODUCTION
7.2 MERGING OF ADAPTED SEM MODEL AND THE FINDINGS TO INFORM THE GUIDELINES
7.3 DEVELOPMENT OF GUIDELINES
7.4 GUIDING PRINCIPLES USED FOR THE DEVELOPMENT OF GUIDELINES
7.5 THEORETICAL GUIDANCE ON GUIDELINES DEVELOPMENT AND REFINEMENT
7.6 METHOD OF DEVELOPING AND REFINING GUIDELINES
7.7 PRESENTATION OF THE DEVELOPED GUIDELINES
7.8 ENSURING TRUSTWORTHINESS
7.9 DISSEMINATION OF GUIDELINES
7.10 VALIDATION, REVIEWING AND UPDATING THE GUIDELINES
7.11 CONCLUSION
CHAPTER 8 FINDINGS, CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS
8.1 INTRODUCTION
8.2 AIM OF THE STUDY
8.3 OBJECTIVES OF THE STUDY
8.4 RESEARCH DESIGN AND METHODS
8.5 DESCRIPTION OF THE FINAL GUIDELINES
8.6 RECOMMENDATIONS
8.7 CONTRIBUTION TO THE BODY OF KNOWLEDGE IN NURSING
8.8 LIMITATIONS OF THE STUDY
8.9 FINAL CONCLUSION
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